Evaluating the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma: A randomized control trial

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Abstract

Background

Empowerment can be an effective strategy for changing an individual's health behaviours. However, how to empower whole families to manage their children's asthma is a challenge that requires innovative nursing intervention based on family-centred care.

Aims

To evaluate the effectiveness of a family empowerment program on family function and pulmonary function of children with asthma compared to those receiving traditional self-management only.

Methods

Sixty-five families were recruited from one asthma clinic in a medical centre in Taiwan. After random assignment, 34 families in the experimental group received the family empowerment program consisting of four counselling dialogues with the child and its family. We empowered the family caregiver's ability to manage their child's asthma problems through finding the problems in the family, discovery and discussion about the way to solve problems, and enabling the family's cooperation and asthma management. The other 31 families received the traditional care in asthma clinics. The Parental Stress Index and Family Environment Scale of family caregivers, and pulmonary function, and asthma signs of children with asthma were collected at pre-test, 3-month post-test, and one-year follow-up. We utilized the linear mixed model in SPSS (18.0) to analyze the effects between groups, across time, and the interaction between group and time.

Results

The family empowerment program decreased parental stress (F = 13.993, p < .0001) and increased family function (cohesion, expression, conflict solving, and independence) (F = 19.848, p < .0001). Children in the experimental group had better pulmonary expiratory flow (PEF) (F = 26.483, p < .0001) and forced expiratory volume in first second (FEV1) (F = 7.381, p = .001) than children in the comparison group; however, no significant change in forced expiratory volume in first second (FEV1)/forced vital capacity (FVC) was found between the two groups. Sleep problems did not show significant changes but cough, wheezing, and dyspnoea were significantly reduced by family caregiver's observations.

Conclusion

We empowered families by listening, dialogues, reflection, and taking action based on Freire's empowerment theory. Nurses could initiate the families’ life changes and assist children to solve the problems by themselves, which could yield positive health outcomes.

Introduction

Childhood asthma is a highly prevalent chronic illness (Chang et al., 2013, Yeh et al., 2011) and affects many families’ lives (Svavarsdottir and Rayens, 2005). Complicated asthma management and recurrent asthma exacerbations could disturb family relationships and threaten daily family life (Santer et al., 2014), as well as cause parent–child discord for children with moderate asthma (Chiang, 2005). Parents suffer from high stress as they take on the responsibilities of self-managing asthma care for their children within the context of family life (Brown et al., 2010). Families with higher levels of family dysfunction and chronic family stress have shown that the children suffer from increased inflammatory production and asthma symptoms (Marin et al., 2009). Family function has also been shown to be a protector and benefit in coping with a childhood chronic illness (Rosland et al., 2010). However, previous interventions for improving the self-management for children with asthma were focused on asthma knowledge and disease management with educational and behavioural interventions (Clark et al., 2010, Guevara et al., 2003). The self-management plan predominantly emphasized a personal action asthma plan (Ring et al., 2007). Most self-management programs (Ahmad and Grimes, 2011, Welsh et al., 2011) emphasize only a caregiver's responsibility of monitoring adherence to treatment and not a comprehensive family care approach to address relieving parental stress or increasing family function (Horner, 1995).

For successful management, a case manager should consistently and patiently meet with the family to build a trusting relationship (Schulte et al., 2004). The major responsibility of paediatric nurses is providing holistic family-centred nursing care to improve family function (Kuhlthau et al., 2011) and to maintain a well-controlled asthma regimen for children to have normal growth and development. Until now, there has been no study implementing family empowerment methods and examining the effects on parental stress, family function, and the asthma conditions of children with asthma.

We developed the Asthma Family Empowerment Program (AFEP) based on Freire's empowerment theory to recruit the whole family with asthmatic children into the nursing intervention.

Section snippets

Family function and parental stress

Reviews of parental stress indicated that parental stress increases the risk of childhood wheezing among children with no parental history of asthma (Milam et al., 2008, Yamamoto and Nagano, 2015). Interactively, the family function and parent–child relationships, and management ability also influence the health of children with asthma (Preechawong et al., 2007). Two previous studies that have examined the effects of parental stress on the incidence of childhood asthma and wheezing, indicated

Aims

The aim of this study was to examine the effectiveness of the asthma family empowerment program (AFEP) for parents on parental stress, family function, and children's pulmonary function and asthma symptoms; in addition, we compared these families to families who only had self-management.

Study design

The study design was a randomized control trial to repeatedly measure the parental stress, family function, and children's pulmonary function and asthma symptoms. We measured three time points, including baseline and three-month and one-year follow-ups. A family empowerment program was implemented for 1.5 years and included four sessions over sixteen weeks.

Participants

Families with asthmatic children were recruited from a medical centre in middle Taiwan. Selection criteria included the following: (a) a

Demographic data of children and family

Table 2 showed the demographic data of children and their primary family caregivers in two groups. There were no significant differences between the groups in terms of gender, age, asthma severity, or marital status of family caregivers.

Parental stress and family function

Table 3 showed the average score of the Parental Stress Index (PSI) was significantly reduced from baseline (229.88) to three months (202.12), to one year (195.32) in the experimental group compared with the comparison group at baseline, and three months and

Discussion

The results of this study indicate that the Asthma Family Empowerment Program (AFEP) based on Freire's empowerment theory can reduce parental stress and improve family function (subscales of Cohesion, Expressiveness, Conflict, and Independent) from parents’ perceptions, as well as improve children's pulmonary function (FEV1, PEF) and reduce daily asthma symptoms compared with only asthma self-management interventions after one year of follow-up.

This study selected dysfunctional families whose

Conclusion

Childhood asthma is a condition that affects families, as they must manage a child with a complicated illness, which may lead to increased parental stress and impaired family function. The Asthma Family Empowerment Program (AFEP) is needed to develop and implement empowering strategies for families to care a child with chronic asthma. Resolving the impact of asthma on parental stress and enabling family function could improve children's pulmonary function and decrease their asthmatic

Implication for practice and policy

A child with a chronic illness affects the whole family. The asthma self-management intervention for children with asthma is a regularly provided service in current asthma clinics. Paediatric nurses can provide the intervention series to families and empower them by having them listen, dialogue, reflect on, and act out their problem solving ideas while making regular clinic visits. Continuing education and service training programs for paediatric nurses to improve their competency on empowering

Acknowledgements

This is supported by grants from the National Science Council (no. NSC97-2314-B-039-034-MY3). And the administrative support from the department of paediatric in China Medical University.
Conflict of interest. This is a follow-up evaluation study conducted by the researcher without conflict of interest.
Funding. This study is an experimental study that research nurse (first author) was a graduate student and was supported by the advisor Dr. Chiang for the cost from grant

References (58)

  • G. Cameron et al.

    Fostering empowering participation in prevention programs for disadvantaged children and families: lessons from ten demonstration sites

    Can. J. Commun. Ment. Health

    (1999)
  • W.C. Chang et al.

    Close correlation between season of birth and the prevalence of bronchial asthma in a Taiwanese population

    PLOS ONE

    (2013)
  • J.Y. Chen et al.

    Family function in families of children with Duchenne muscular dystrophy

    Fam. Community Health

    (2007)
  • Y.H. Chan

    Biostatistics 301A: repeated measurement analysis (Mixed Models)

    Singapore Med. J.

    (2004)
  • L.C. Chiang

    Exploring the health-related quality of life among children with moderate asthma

    J. Nurs. Res.

    (2005)
  • L.C. Chiang et al.

    Effects of a self-management asthma educational program in Taiwan based on PRECEDE-PROCEED model for parents with asthmatic children

    J. Asthma

    (2004)
  • N.M. Clark et al.

    Educational and behavioral interventions for asthma: who achieves which outcomes? A systematic review

    J. Asthma Allergy

    (2010)
  • J. Cohen

    Statistical Power Analysis for the Behavioral Sciences

    (1988)
  • Y.S. Eo

    Effects of an empowerment program on the burden of mothers having a child with cerebral palsy

    J. Korean Acad. Nurs.

    (2005)
  • P. Freire

    Pedagogy of Hope

    (1994)
  • GINA

    Global Strategy for Asthma Management and Prevention

    (2010)
  • J.P. Guevara et al.

    Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis

    BMJ

    (2003)
  • J.H. Hawks

    Empowerment in nursing education: concept analysis and application to philosophy, learning and instruction

    J. Adv. Nurs.

    (1992)
  • S.D. Horner

    A family care approach for managing childhood asthma

    J. Am. Acad. Nurse Pract.

    (1995)
  • K.D. Juang et al.

    Association between adolescent chronic daily headache and childhood adversity: a community-based study

    Cephalalgia

    (2004)
  • S. Kelcher et al.

    Teaching residents to use asthma devices. Assessing family residents’ skills and a brief intervention

    Can. Fam. Physician

    (1994)
  • G. Kmita et al.

    Psychosocial intervention in the process of empowering families with children living with HIV/AIDS – a descriptive study

    AIDS Care

    (2002)
  • E.L. Kurnat et al.

    The impact of a chronic condition on the families of children with asthma

    Pediatr. Nurs.

    (1999)
  • K.A. Kuhlthau et al.

    Evidence for family-centered care for children with special health care needs: a systematic review

    Acad. Pediatr.

    (2011)
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